3 SUBJECTIVEPatient came with a complain of Fever, Headache and BreathlessnessSever and generated neck stiffness and pain.History of Present IllnessC/o fever from 10 days a/w chills and rigorsBitter taste in mouth and vomiting.C/o of headache from last 8-10 daysC/o of vomiting. Only one episode yet,Not projectile ,immediate after food.Breathlessness on lying down & on walking about 500 metres

10 CXR: Small cyst area are seen in both lower zone. Chest X-Ray:- P/A view - Cavities are seen which suggests presence of TBGram Staining of Sputum – Positive (+ve)Ultrasound of Abdomen and Pelvis on 09/01/12Mild Hepatomegaly (Grade –I)

13 Planning Suggestion to PhysicianOndansetron may cause Bronchospasm and so instead some other type of antiemetics may presecribed E.g: Domperidone.Pantoprazole has ADR of bronchitis, cough, sinusitis and neck pain , so it should be replaced with RanitidineSparfloxacin should not be given with NSAID’s , there are chances of developing seizuresParacetamol increases the risk of lever damage in alcoholics and the person is already diagnosed with Hepatomegaly.Prescribe some 1st line antitubercular drug.

14 Advice to Patient Adhere to dose regimen Take meal with Fatty DietMaintain Hygienic ConditionDo not split and cough in public.Avoid going out or in area where pollution is more. (to avoid bronchopneumonia condition)